Climate-driven malaria mortality among children in malaria-endemic areas of Uganda.

Malaria is a major disease in Africa and is among the leading causes of mortality among children. The disease is highly sensitive to climate change. Prior studies have established a link between climatic factors and malaria mortality, but the evidence specifically related to children in sub-Saharan Africa remains inconsistent and requires further investigation. This study examined the impact of climate variables on malaria mortality in the Iganga and Mayuge districts, a malaria-prone area in Uganda. We used weekly malaria mortality data from a population-based cohort in the Iganga Mayuge Health Demographic Surveillance Site (IMHDSS). In this study, we employed a time series model using a distributed lag non-linear approach to assess the association of weekly climatic factors on malaria mortality across all ages, including children under 5 years and children aged between 5 and 14 years. We also conducted a subgroup analysis based on sex to determine whether susceptibility to climate-related malaria mortality differs between females and males. We found an increased mortality risk across all ages at a lag of 11 to 12 weeks following exposure to rainfall above 646 mm. Higher risks of malaria mortality were also observed at a lag of 5 to 11 weeks when temperatures ranged between 25.2 °C and 29.9 °C. Notably, the relative risk of malaria mortality in children under 5 years and children aged between 5 and 14 years was more sensitive to temperature than to rainfall. We found that male children aged between 5 and 14 years were more vulnerable to temperature-related malaria mortality compared to females in that age group and children under 5 years. Rainfall did not have a significant association with malaria mortality in children. A nuanced understanding of climate-malaria relationships has the potential to inform the implementation of malaria prevention and control strategies through early warnings of climate-driven risks, ultimately reducing premature deaths due to malaria in this vulnerable age group.